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. . _ �_ . .� . _ : , <br /> _ .__ _ <br /> ___ _ . , , <br /> Date s � y/(�/ �/— <br /> J��� Pu01¢Works Perml�l• ��U((J��� {U <br /> Hpp�ication For � e�a9.nao�.• Cr6 //f��� ' <br /> —�y---=— <br /> PUBLIC WORKS PERMIT P�o�,�Wo�k=Fea — <br /> rcia�Fce S _ <br /> Lti55RODLF���i�p.i� �5.�_ <br /> Print or Type Only � s,���:Ao�e :i ���.�— <br /> _�.,�'�re�r �.c���' /SG� r� t� -� a `�P��'�.. ��...s,U�� �.SoZ —O.i7J� <br /> Owner Mailing ACSdress City Zip ?hone <br /> Applicant Mailiny Address City Zip Pnone <br /> Describe Proposed Work \���� <br /> _'_ I <br /> /� - .; -- W <br /> Proiec!Address�if known) (-�--c�' �S /Q��fj7 —,S — ��j�.: ,SE <br /> Attach fcur(4) :opies of plans for proposed work- Oraw to scale and note the lollowing as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed structures on;he lot • Show any proposed grading changes <br /> • Existing and prOposed utilities • Show measuremen�s � <br /> DO NOT WRITE BELOW THIS UNE <br /> PERMIT CONDITIONS O <br />� 1. All calls lor inspec�ion shall be made 24 hrs. in adcance• phone 259-5£1 5. � <br /> 2. All work snaii be performed in accordance with this permit and current City of Evr.retl Desig�n and Construction <br /> Standards and Specificatinns. <br /> 3. Call Location Underground ;,ervice 48 hrs. before you dig.TOLL FREE NUMOER 1•800•424-5555. � <br /> 4. ANY GRADING DONE ON THIS LOT SHALL BF, DONE SO AS NOT TO IMPACT THE <br /> SURROUIdDING TATS WITH RAINWATER RUNOFF. O <br /> 5. AN; CURB & GUTTER OR SIDEWALK DA[9AGEU DURING CONSTRUCTION SHALL BE <br /> REPLACED BY THE APPLICANT, � <br /> 6. DOWNSPOUTS FROM THE HOUSE ARE TO BE TIGHT—LINED TO THE DR�INAGE SYSTi;M, � <br /> 7.ANY ORGANIC MATERIAL ON SITE TO BE DURNED OR HAULED OFF WITH PERMITS. � <br /> � <br /> ACKNOWLEDGEP�IENT OF CONDITIONS <br />_ The undersigned owner/app!icanl hereby agrees to Fold and save harm- <br /> � te;s Ihe City of EvereU from any and all claims for damages, costs. <br /> expenses, or causes of action Ihat rnay arise because of installa,�on <br /> �� �j��� L�l��j/�� and mainlenance ol the improvement or other ric�hl�of•way use 1ere;o <br /> Approved for Consf .tion <br /> � applied lor and further ag�ees to remove same upo� nntice irom ,ne <br /> City and to ieplace public property damaged thereby. <br /> - . � ^ <br /> FINAL INSPECTION �t�- ��Vl CLC.��-�� <br /> Approved as Constructed Si na re of Applicanl Date <br /> everett PUBLIC WORKS DEPARTMENT WOfdK AUTFiORIZED BY THIS PEaMl7 MUST BE STA(iTED NJITHIN <br /> � 3200 Ceda�Street 180 CAYS OF DATE 'ERMIT IS ISSUED AND THER[AFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TC COh7PLETION. THIS PERMI7 MAY BE <br /> �hone: 259-8815 CANCEtLED BY THE CITY UPnF AN� STOPPAGE OF WORK OPJ iMIS <br /> PROJEC?OVER 90 DAYS DUHAIIOW. <br />